Associations Between Subclinical Thyroid Dysfunction and Cardiovascular Risk Factors According to Age and Sex

The Journal of Clinical Endocrinology & Metabolism, vol. 110, pp. e1315–e1322

Abstract

CONTEXT: Subclinical thyroid dysfunction (ScTD), comprising subclinical hypothyroidism (SHypo) and subclinical hyperthyroidism (SHyper), has been associated with increased risk for cardiovascular events. OBJECTIVE: To assess associations between ScTD and cardiovascular risk factors (cvRFs) according to age and sex. METHODS: This analysis of pooled participant data from large prospective cohort studies from the Thyroid Studies Collaboration assessed cvRFs (blood pressure [BP], lipid levels, high-sensitivity C-reactive protein [hs-CRP]) among participants aged 18 to 103 years with SHypo (thyroid-stimulating hormone [TSH] > 4.50 mU/L, normal fT4) and SHyper (TSH < 0.45 mU/L, normal fT4) vs euthyroid (TSH 0.45-4.50 mU/L). RESULTS: Of 69 006 participants (mean age 62 years, 55% women, 25% current smokers) from 16 international cohorts, 3748 (5.4%) had SHypo and 3428 (5.0%) had SHyper. In both women and men, systolic and diastolic BP were similar regardless of thyroid status. Exceptions were lower diastolic BP in women with SHyper compared to euthyroid participants (adjusted mean difference [aMD] -1.3 mmHg, 95% CI -2.0 to -0.5), and lower systolic BP in men with SHyper compared to euthyroid participants (aMD -3.1 mmHg, 95% CI -4.8 to -1.4). In both women and men, lipid levels (total, HDL, LDL-cholesterol, triglycerides) and hs-CRP were similar regardless of thyroid status. The only exception were women with SHyper who had lower LDL-cholesterol vs euthyroid (aMD -0.17 mmol/L, 95% CI -0.29 to -0.05). CONCLUSION: Participants with ScTD and euthyroid participants have similar cvRFs and differences are arguably too small to explain the increased cardiovascular risk in ScTD observed in previous studies.

Authors 32

1. Oliver Baretella

   University of Bern · University Hospital of Bern

   Affiliation as printed

   Department of General Internal Medicine, Inselspital, Bern University Hospital , 3010 Bern ,

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

2. Manuel R. Blum

   University of Bern · University Hospital of Bern

   Affiliation as printed

   Department of General Internal Medicine, Inselspital, Bern University Hospital , 3010 Bern ,

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

3. Nazanin Abolhassani

   University of Bern · Centre universitaire de médecine générale et santé publique, Lausanne · University of Lausanne

   Affiliation as printed

   Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne , 1011 Lausanne ,

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne ,

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

4. Heba Alwan

   University of Bern

   Affiliation as printed

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

5. Lea Wildisen

   University of Bern

   Affiliation as printed

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

6. Cinzia Del Giovane

   University of Bern

   Affiliation as printed

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

7. Kali Tal

   University of Bern

   Affiliation as printed

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

8. Elisavet Moutzouri

   University of Bern · University Hospital of Bern

   Affiliation as printed

   Department of General Internal Medicine, Inselspital, Bern University Hospital , 3010 Bern ,

   Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

   Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland

   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

9. Bjørn Olav Åsvold

   Norwegian University of Science and Technology · St Olav's University Hospital

   Affiliation as printed

   Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital , 7030 Trondheim ,

   HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology , 7491 Trondheim ,

   HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology , 7600 Levanger ,

   Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

   HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

   HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway

10. Anne Rentoumis Cappola

    University of Pennsylvania

    Affiliation as printed

    Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine , Philadelphia, PA 19104-5160 ,

    Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA

11. Jacobijn Gussekloo Aachen LUMC Center for Medicine for older people Department of Public Health and Primary Care (PHEG) Department of Internal Medicine section Gerontology and Geriatrics

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    LUMC Center for Medicine for older people, Department of Public Health and Primary Care, and Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center , 2333 ZD Leiden ,

    LUMC Center for Medicine for older people, Department of Public Health and Primary Care, and Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands

12. Massimo Iacoviello

    University of Bari Aldo Moro

    Affiliation as printed

    Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari , 70124 Bari ,

    Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Bari, Italy

13. Giorgio Iervasi

    Istituto di Fisiologia Clinica · National Research Council · Fondazione Toscana Gabriele Monasterio

    Affiliation as printed

    National Research Council, Institute of Clinical Physiology, Tuscany Region G. Monasterio Foundation , 56124 Pisa ,

    National Research Council, Institute of Clinical Physiology, Tuscany Region G. Monasterio Foundation, Pisa, Italy

14. Misa Imaizumi

    Radiation Effects Research Foundation

    Affiliation as printed

    Department of Clinical Studies, Radiation Effects Research Foundation , Nagasaki 850-0013 ,

    Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan

15. Stefan Weiler

    ETH Zurich · University Hospital Zurich · Institute of Pharmaceutical Sciences

    Affiliation as printed

    Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH , 8093 Zurich ,

    Institute of Primary Care, University and University Hospital Zurich , 8091 Zurich ,

    Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH, Zurich, Switzerland

    Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland

16. Salman Razvi

    Newcastle University

    Affiliation as printed

    Translational and Clinical Research Institute, Newcastle University , Newcastle upon Tyne NE1 3BZ ,

    Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

17. José Augusto Sgarbi

    Faculdade de Medicina de Marília

    Affiliation as printed

    Division of Endocrinology, Faculdade de Medicina de Marília , Marília, São Paulo 17519 ,

    Division of Endocrinology, Faculdade de Medicina de Marília , Marília ,

18. Henry Völzke

    Universitätsmedizin Greifswald · Universität Greifswald

    Affiliation as printed

    Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald , 17489 Greifswald ,

    Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Germany

19. Suzanne J. Brown

    The University of Western Australia · Sir Charles Gairdner Hospital

    Affiliation as printed

    Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Nedlands, Western Australia 6009 ,

    Medical School, University of Western Australia , Crawley, Western Australia 6009 ,

    Medical School, University of Western Australia, Crawley, Western Australia

    Medical School, University of Western Australia, Crawley, Western Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Nedlands, Western Australia ,

20. John P. Walsh

    The University of Western Australia · Sir Charles Gairdner Hospital

    Affiliation as printed

    Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Nedlands, Western Australia 6009 ,

    Medical School, University of Western Australia , Crawley, Western Australia 6009 ,

    Medical School, University of Western Australia, Crawley, Western Australia

    Medical School, University of Western Australia, Crawley, Western Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Nedlands, Western Australia ,

21. Bert Vaes

    KU Leuven

    Affiliation as printed

    Department of Public Health and Primary Care, KU Leuven , 3000 Leuven ,

    Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium

22. Bu Beng Yeap

    The University of Western Australia · Fiona Stanley Hospital

    Affiliation as printed

    Department of Endocrinology and Diabetes, Fiona Stanley Hospital , Perth, Western Australia 6150 ,

    Medical School, University of Western Australia , Perth, Western Australia 6009 ,

    Medical School, University of Western Australia, Perth, Australia

    Medical School, University of Western Australia, Perth, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital , Perth ,

23. Robin P. F. Dullaart

    University Medical Center Groningen · University of Groningen

    Affiliation as printed

    Department of Internal Medicine, University Medical Center Groningen, University of Groningen , 9713 AV Groningen ,

    Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

24. Stephan J. L. Bakker

    University Medical Center Groningen · University of Groningen

    Affiliation as printed

    Department of Internal Medicine, University Medical Center Groningen, University of Groningen , 9713 AV Groningen ,

    Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

25. Maryam Kavousi

    Erasmus MC

    Affiliation as printed

    Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam , 3015 GD Rotterdam ,

    Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

26. Graziano Ceresini

    University of Parma · Ospedale di Parma

    Affiliation as printed

    Unit of Internal Medicine and Oncological Endocrinology, University of Parma, University Hospital Parma , 43121 Parma ,

    Unit of Internal Medicine and Oncological Endocrinology, University of Parma, University Hospital Parma, Parma, Italy

27. Luigi Ferrucci

    National Institute on Aging

    Affiliation as printed

    National Institutes on Aging, Longitudinal Studies Section , Baltimore, MD 21225-1233 ,

    National Institutes on Aging, Longitudinal Studies Section, Baltimore, USA

28. Drahomir Aujesky

    University Hospital of Bern

    Affiliation as printed

    Department of General Internal Medicine, Inselspital, Bern University Hospital , 3010 Bern ,

    Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland

29. Robin Patrick Peeters

    Erasmus MC

    Affiliation as printed

    Department of Internal Medicine, Erasmus Medical Center , 3015 GD Rotterdam ,

    Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands

30. Douglas C. Bauer

    University of Bern · University of California, San Francisco

    Affiliation as printed

    Department of Epidemiology and Biostatistics, University of California , San Francisco, CA 94158 ,

    Department of Medicine, University of California , San Francisco, CA 94115 ,

    Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

    Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, USA

    Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

31. Martin Feller

    University of Bern

    Affiliation as printed

    Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

    Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

32. Nicolas Rodondi corresponding

    University of Bern · University Hospital of Bern

    Affiliation as printed

    Department of General Internal Medicine, Inselspital, Bern University Hospital , 3010 Bern ,

    Institute of Primary Health Care (BIHAM), University of Bern , 3012 Bern ,

    Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland

    Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland